Causes local irritation of the upper GI mucosa. Caution in patients w/ active upper GI problems eg, dysphagia, oesophageal disease, gastritis, duodenitis, ulcers, or w/ recent history (1 yr) of major GI diseases eg, peptic ulcer, or active GI bleeding, or upper GIT surgery other than pyloroplasty. Risk of oesophageal reactions; greater risk & severity in patients who fail to take alendronate properly &/or who continue to take alendronate after developing symptoms suggestive of oesophageal irritation. Reports of osteonecrosis of the jaw. Avoid invasive dental procedures if possible while on treatment. Encourage patients to maintain good oral hygiene, receive routine dental check-ups, & report any oral symptoms eg, dental mobility, pain or swelling. Reports of bone, joint, &/or muscle pain; atypical subtrochanteric & diaphyseal femoral fractures, primarily in patients receiving long-term treatment for osteoporosis; severe skin reactions including SJS & TEN (rare); osteonecrosis of the external auditory canal, mainly in association w/ long-term therapy. Hypocalcaemia must be corrected before initiating therapy. Other disorders affecting mineral metabolism (eg, vit D deficiency & hypoparathyroidism) should be effectively treated before starting treatment; monitor serum Ca & symptoms of hypocalcaemia during therapy in patients w/ these conditions. Decreases in serum Ca & phosphate may occur especially in patients taking glucocorticoids. Ensure adequate Ca & vit D intake, particularly in patients receiving glucocorticoids. Contains 26.2 mmol (602.54 mg) Na/dose; consider Na content in patients on controlled Na diet. Certain reported adverse reactions may affect some patients' ability to drive or operate machinery. Not recommended in patients w/ renal impairment where GFR is <35 mL/min. Not to be used during pregnancy. Should not be used by breast-feeding women. Not recommended for use in childn <18 yr.
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